Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa
Identifieur interne : 000795 ( Pmc/Checkpoint ); précédent : 000794; suivant : 000796Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa
Auteurs : Muhammad Hamza [Nigeria] ; Maryam A. Idris [Nigeria] ; Musa B. Maiyaki [Nigeria] ; Mohammed Lamorde [Ouganda] ; Jean-Philippe Chippaux [France] ; David A. Warrell [Royaume-Uni] ; Andreas Kuznik [Nigeria, Ouganda, États-Unis] ; Abdulrazaq G. Habib [Nigeria]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2016.
Abstract
Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa.
We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (
The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition, the PSA showed that in the majority of iterations ranging from 97.3% in Liberia to 100% in Cameroun, Guinea Bissau, Mali, Nigeria and Senegal, our model results yielded an ICER that fell below the threshold of one time per capita GDP, thus, indicating a high degree of confidence in our results.
Therapy for SBE with AV in countries of WA is highly cost-effective at commonly accepted thresholds. Broadening access to effective AVs in rural communities in West Africa is a priority.
Url:
DOI: 10.1371/journal.pntd.0004568
PubMed: 27027633
PubMed Central: 4814077
Affiliations:
- France, Nigeria, Ouganda, Royaume-Uni, États-Unis
- Angleterre, New Jersey, Oxfordshire, Île-de-France
- Oxford, Paris
- Université Paris-Descartes, Université d'Oxford
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Idris</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>College of Health of Sciences, Bayero University, Kano, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>College of Health of Sciences, Bayero University, Kano</wicri:regionArea><wicri:noRegion>Kano</wicri:noRegion></affiliation></author><author><name sortKey="Maiyaki, Musa B" sort="Maiyaki, Musa B" uniqKey="Maiyaki M" first="Musa B." last="Maiyaki">Musa B. Maiyaki</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>College of Health of Sciences, Bayero University, Kano, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>College of Health of Sciences, Bayero University, Kano</wicri:regionArea><wicri:noRegion>Kano</wicri:noRegion></affiliation></author><author><name sortKey="Lamorde, Mohammed" sort="Lamorde, Mohammed" uniqKey="Lamorde M" first="Mohammed" last="Lamorde">Mohammed Lamorde</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda</addr-line></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation></author><author><name sortKey="Chippaux, Jean Philippe" sort="Chippaux, Jean Philippe" uniqKey="Chippaux J" first="Jean-Philippe" last="Chippaux">Jean-Philippe Chippaux</name><affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>Institut de Recherche pour le Development, Cotonou, Benin Republic and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Institut de Recherche pour le Development, Cotonou, Benin Republic and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement><settlement type="city">Paris</settlement></placeName><orgName type="university">Université Paris-Descartes</orgName></affiliation></author><author><name sortKey="Warrell, David A" sort="Warrell, David A" uniqKey="Warrell D" first="David A." last="Warrell">David A. Warrell</name><affiliation wicri:level="4"><nlm:aff id="aff004"><addr-line>Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Nuffield Department of Medicine, University of Oxford, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation></author><author><name sortKey="Kuznik, Andreas" sort="Kuznik, Andreas" uniqKey="Kuznik A" first="Andreas" last="Kuznik">Andreas Kuznik</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>College of Health of Sciences, Bayero University, Kano, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>College of Health of Sciences, Bayero University, Kano</wicri:regionArea><wicri:noRegion>Kano</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda</addr-line></nlm:aff><country xml:lang="fr">Ouganda</country><wicri:regionArea>Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala</wicri:regionArea><wicri:noRegion>Kampala</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Celgene Corporation, Warren, New Jersey, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Celgene Corporation, Warren, New Jersey</wicri:regionArea><placeName><region type="state">New Jersey</region></placeName></affiliation></author><author><name sortKey="Habib, Abdulrazaq G" sort="Habib, Abdulrazaq G" uniqKey="Habib A" first="Abdulrazaq G." last="Habib">Abdulrazaq G. Habib</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>College of Health of Sciences, Bayero University, Kano, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>College of Health of Sciences, Bayero University, Kano</wicri:regionArea><wicri:noRegion>Kano</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa.</p></sec><sec id="sec002"><title>Methods</title><p>We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (<italic>Echis</italic> species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs.</p></sec><sec id="sec003"><title>Results</title><p>The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition, the PSA showed that in the majority of iterations ranging from 97.3% in Liberia to 100% in Cameroun, Guinea Bissau, Mali, Nigeria and Senegal, our model results yielded an ICER that fell below the threshold of one time per capita GDP, thus, indicating a high degree of confidence in our results.</p></sec><sec id="sec004"><title>Conclusions</title><p>Therapy for SBE with AV in countries of WA is highly cost-effective at commonly accepted thresholds. Broadening access to effective AVs in rural communities in West Africa is a priority.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author><author><name sortKey="Arnett, C" uniqKey="Arnett C">C Arnett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Visser, L E" uniqKey="Visser L">L.E. Visser</name></author><author><name sortKey="Kyei Faried, S" uniqKey="Kyei Faried S">S. Kyei-Faried</name></author><author><name sortKey="Belcher, D W" uniqKey="Belcher D">D.W. Belcher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Enwere, Gc" uniqKey="Enwere G">GC Enwere</name></author><author><name sortKey="Obu, Ha" uniqKey="Obu H">HA Obu</name></author><author><name sortKey="Jobarteh, A" uniqKey="Jobarteh A">A Jobarteh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fayomi, B" uniqKey="Fayomi B">B Fayomi</name></author><author><name sortKey="Massougbodji, A" uniqKey="Massougbodji A">A Massougbodji</name></author><author><name sortKey="Chobli, M" uniqKey="Chobli M">M Chobli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Trape, Jf" uniqKey="Trape J">JF Trape</name></author><author><name sortKey="Pison, G" uniqKey="Pison G">G Pison</name></author><author><name sortKey="Guyavarch, E" uniqKey="Guyavarch E">E Guyavarch</name></author><author><name sortKey="Mane, Y" uniqKey="Mane Y">Y Mane</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chippaux, Jp" uniqKey="Chippaux J">JP Chippaux</name></author><author><name sortKey="Massougbodji, A" uniqKey="Massougbodji A">A Massougbodji</name></author><author><name sortKey="Stock, Rp" uniqKey="Stock R">RP Stock</name></author><author><name sortKey="Alagon, A" uniqKey="Alagon A">A Alagon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chippaux, J P" uniqKey="Chippaux J">J-P Chippaux</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kasturiratne, A" uniqKey="Kasturiratne A">A Kasturiratne</name></author><author><name sortKey="Wickremasinghe, Ar" uniqKey="Wickremasinghe A">AR Wickremasinghe</name></author><author><name sortKey="De Silva, Nr" uniqKey="De Silva N">NR de Silva</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pugh, Rnh" uniqKey="Pugh R">RNH Pugh</name></author><author><name sortKey="Theakston, Rdg" uniqKey="Theakston R">RDG Theakston</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author><author><name sortKey="Davidson, Nmcd" uniqKey="Davidson N">NMcD Davidson</name></author><author><name sortKey="Greenwood, Bm" uniqKey="Greenwood B">BM Greenwood</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meyer, Wp" uniqKey="Meyer W">WP Meyer</name></author><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author><author><name sortKey="Onayade, Aa" uniqKey="Onayade A">AA Onayade</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author><author><name sortKey="Barnes, Hj" uniqKey="Barnes H">HJ Barnes</name></author><author><name sortKey="Pirburn, Mf" uniqKey="Pirburn M">MF Pirburn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pugh, Rnh" uniqKey="Pugh R">RNH Pugh</name></author><author><name sortKey="Theakston, Rdg" uniqKey="Theakston R">RDG Theakston</name></author><author><name sortKey="Reid, Ha" uniqKey="Reid H">HA Reid</name></author><author><name sortKey="Bhar, Is" uniqKey="Bhar I">IS Bhar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Muguti, Gi" uniqKey="Muguti G">GI Muguti</name></author><author><name sortKey="Maramba, A" uniqKey="Maramba A">A Maramba</name></author><author><name sortKey="Washaya, Ct" uniqKey="Washaya C">CT Washaya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author><author><name sortKey="Ormerod, Ld" uniqKey="Ormerod L">LD Ormerod</name></author><author><name sortKey="Davidson, Nmcd" uniqKey="Davidson N">NMcD Davidson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author><author><name sortKey="Ormerod, Ld" uniqKey="Ormerod L">LD Ormerod</name></author><author><name sortKey="Davidson, Nmcd" uniqKey="Davidson N">NMcD Davidson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author><author><name sortKey="Greenwood, Bm" uniqKey="Greenwood B">BM Greenwood</name></author><author><name sortKey="Davidson, Nmcd" uniqKey="Davidson N">NMcD Davidson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author><author><name sortKey="Ormerod, Ld" uniqKey="Ormerod L">LD Ormerod</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mustapha, Sk" uniqKey="Mustapha S">SK Mustapha</name></author><author><name sortKey="Mubi, Bm" uniqKey="Mubi B">BM Mubi</name></author><author><name sortKey="Askira, Bh" uniqKey="Askira B">BH Askira</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author><author><name sortKey="Abubakar, Sb" uniqKey="Abubakar S">SB Abubakar</name></author><author><name sortKey="Abubakar, Is" uniqKey="Abubakar I">IS Abubakar</name></author><author><name sortKey="Larnyang, S" uniqKey="Larnyang S">S Larnyang</name></author><author><name sortKey="Durfa, N" uniqKey="Durfa N">N Durfa</name></author><author><name sortKey="Nasidi, A" uniqKey="Nasidi A">A Nasidi</name></author><author><name sortKey="Yusuf, Po" uniqKey="Yusuf P">PO Yusuf</name></author><author><name sortKey="Garnvwa, J" uniqKey="Garnvwa J">J Garnvwa</name></author><author><name sortKey="Theakston, Rdg" uniqKey="Theakston R">RDG Theakston</name></author><author><name sortKey="Salako, L" uniqKey="Salako L">L Salako</name></author><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Ss" uniqKey="Williams S">SS Williams</name></author><author><name sortKey="Wijesinghe, Ca" uniqKey="Wijesinghe C">CA Wijesinghe</name></author><author><name sortKey="Jayamanne, Sf" uniqKey="Jayamanne S">SF Jayamanne</name></author><author><name sortKey="Buckley, Na" uniqKey="Buckley N">NA Buckley</name></author><author><name sortKey="Dawson, Ah" uniqKey="Dawson A">AH Dawson</name></author><author><name sortKey="Lalloo, Dg" uniqKey="Lalloo D">DG Lalloo</name></author><author><name sortKey="De Silva, Hj" uniqKey="De Silva H">HJ de Silva</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abubakar, Is" uniqKey="Abubakar I">IS Abubakar</name></author><author><name sortKey="Abubakar, Sb" uniqKey="Abubakar S">SB Abubakar</name></author><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author><author><name sortKey="Nasidi, A" uniqKey="Nasidi A">A Nasidi</name></author><author><name sortKey="Durfa, N" uniqKey="Durfa N">N Durfa</name></author><author><name sortKey="Yusuf, Po" uniqKey="Yusuf P">PO Yusuf</name></author><author><name sortKey="Larnyang, S" uniqKey="Larnyang S">S Larnyang</name></author><author><name sortKey="Garnvwa, J" uniqKey="Garnvwa J">J Garnvwa</name></author><author><name sortKey="Sokomba, E" uniqKey="Sokomba E">E Sokomba</name></author><author><name sortKey="Salako, L" uniqKey="Salako L">L Salako</name></author><author><name sortKey="Theakston, Rd" uniqKey="Theakston R">RD Theakston</name></author><author><name sortKey="Juszczak, E" uniqKey="Juszczak E">E Juszczak</name></author><author><name sortKey="Alder, N" uniqKey="Alder N">N Alder</name></author><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williams, Dj" uniqKey="Williams D">DJ Williams</name></author><author><name sortKey="Jensen, Sd" uniqKey="Jensen S">SD Jensen</name></author><author><name sortKey="Nimorakiotakis, B" uniqKey="Nimorakiotakis B">B Nimorakiotakis</name></author><author><name sortKey="Muller, R" uniqKey="Muller R">R Müller</name></author><author><name sortKey="Winkel, Kd" uniqKey="Winkel K">KD Winkel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Silva, Ha" uniqKey="De Silva H">HA de Silva</name></author><author><name sortKey="Pathmeswaran, A" uniqKey="Pathmeswaran A">A Pathmeswaran</name></author><author><name sortKey="Ranasinha, Cd" uniqKey="Ranasinha C">CD Ranasinha</name></author><author><name sortKey="Jayamanne, S" uniqKey="Jayamanne S">S Jayamanne</name></author><author><name sortKey="Samarakoon, Snakebite" uniqKey="Samarakoon S">snakebite Samarakoon</name></author><author><name sortKey="Hittharage, A" uniqKey="Hittharage A">A Hittharage</name></author><author><name sortKey="Kalupahana, R" uniqKey="Kalupahana R">R Kalupahana</name></author><author><name sortKey="Ratnatilaka, Ga" uniqKey="Ratnatilaka G">GA Ratnatilaka</name></author><author><name sortKey="Uluwatthage, W" uniqKey="Uluwatthage W">W Uluwatthage</name></author><author><name sortKey="Aronson, Jk" uniqKey="Aronson J">JK Aronson</name></author><author><name sortKey="Armitage, Jm" uniqKey="Armitage J">JM Armitage</name></author><author><name sortKey="Lalloo, Dg" uniqKey="Lalloo D">DG Lalloo</name></author><author><name sortKey="De Silva, Hj" uniqKey="De Silva H">HJ de Silva</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Brown, Ni" uniqKey="Brown N">NI Brown</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Drame, Bs" uniqKey="Drame B">BS Dramé</name></author><author><name sortKey="Dabo, M" uniqKey="Dabo M">M Dabo</name></author><author><name sortKey="Diani, N" uniqKey="Diani N">N Diani</name></author><author><name sortKey="Cisse, B" uniqKey="Cisse B">B Cissé</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chippaux, Jp" uniqKey="Chippaux J">JP Chippaux</name></author><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author><author><name sortKey="Lamorde, M" uniqKey="Lamorde M">M Lamorde</name></author><author><name sortKey="Dalhat, Mm" uniqKey="Dalhat M">MM Dalhat</name></author><author><name sortKey="Habib, Zg" uniqKey="Habib Z">ZG Habib</name></author><author><name sortKey="Kuznik, A" uniqKey="Kuznik A">A Kuznik</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morais, V" uniqKey="Morais V">V Morais</name></author><author><name sortKey="Massaldi, H" uniqKey="Massaldi H">H Massaldi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brown, N" uniqKey="Brown N">N Brown</name></author><author><name sortKey="Landon, J" uniqKey="Landon J">J Landon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chippaux, Jp" uniqKey="Chippaux J">JP Chippaux</name></author><author><name sortKey="Lang, J" uniqKey="Lang J">J Lang</name></author><author><name sortKey="Amadi Eddine, S" uniqKey="Amadi Eddine S">S Amadi-Eddine</name></author><author><name sortKey="Fagot, P" uniqKey="Fagot P">P Fagot</name></author><author><name sortKey="Le Mener, V" uniqKey="Le Mener V">V Le Mener</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Balde, Mc" uniqKey="Balde M">MC Baldé</name></author><author><name sortKey="Chippaux, Jp" uniqKey="Chippaux J">JP Chippaux</name></author><author><name sortKey="Boiro, My" uniqKey="Boiro M">MY Boiro</name></author><author><name sortKey="Stock, R" uniqKey="Stock R">R Stock</name></author><author><name sortKey="Massougbodji, A" uniqKey="Massougbodji A">A Massougbodji</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author><author><name sortKey="Abubakar, Sb" uniqKey="Abubakar S">SB Abubakar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bregani, Er" uniqKey="Bregani E">ER Bregani</name></author><author><name sortKey="Cantoni, F" uniqKey="Cantoni F">F Cantoni</name></author><author><name sortKey="Tantardini, F" uniqKey="Tantardini F">F Tantardini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Visser, Le" uniqKey="Visser L">LE Visser</name></author><author><name sortKey="Kyei Faried, S" uniqKey="Kyei Faried S">S Kyei-Faried</name></author><author><name sortKey="Belcher, Dw" uniqKey="Belcher D">DW Belcher</name></author><author><name sortKey="Geelhoed, Dw" uniqKey="Geelhoed D">DW Geelhoed</name></author><author><name sortKey="Van Leeuwen, Js" uniqKey="Van Leeuwen J">JS van Leeuwen</name></author><author><name sortKey="Van Roosmalen, J" uniqKey="Van Roosmalen J">J van Roosmalen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Drame, Bs" uniqKey="Drame B">BS Dramé</name></author><author><name sortKey="Diarra, A" uniqKey="Diarra A">A Diarra</name></author><author><name sortKey="Diani, N" uniqKey="Diani N">N Diani</name></author><author><name sortKey="Dabo, A" uniqKey="Dabo A">A Dabo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Balde, Mc" uniqKey="Balde M">MC Baldé</name></author><author><name sortKey="Chippaux, Jp" uniqKey="Chippaux J">JP Chippaux</name></author><author><name sortKey="Boiro, My" uniqKey="Boiro M">MY Boiro</name></author><author><name sortKey="Stock, Rp" uniqKey="Stock R">RP Stock</name></author><author><name sortKey="Massougbodji, A" uniqKey="Massougbodji A">A Massougbodji</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Laohawiriyakamol, S" uniqKey="Laohawiriyakamol S">S Laohawiriyakamol</name></author><author><name sortKey="Sangkhathat, S" uniqKey="Sangkhathat S">S Sangkhathat</name></author><author><name sortKey="Chiengkriwate, P" uniqKey="Chiengkriwate P">P Chiengkriwate</name></author><author><name sortKey="Patrapinyokul, S" uniqKey="Patrapinyokul S">S Patrapinyokul</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yates, Vm" uniqKey="Yates V">VM Yates</name></author><author><name sortKey="Lebas, E" uniqKey="Lebas E">E Lebas</name></author><author><name sortKey="Orpiay, R" uniqKey="Orpiay R">R Orpiay</name></author><author><name sortKey="Bale, Bj" uniqKey="Bale B">BJ Bale</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Adehossi, E" uniqKey="Adehossi E">E Adehossi</name></author><author><name sortKey="Sani, R" uniqKey="Sani R">R Sani</name></author><author><name sortKey="Boukari Bawa, M" uniqKey="Boukari Bawa M">M Boukari-Bawa</name></author><author><name sortKey="Niaouro, S" uniqKey="Niaouro S">S Niaouro</name></author><author><name sortKey="Gbaguidi, F" uniqKey="Gbaguidi F">F Gbaguidi</name></author><author><name sortKey="Abdou, I" uniqKey="Abdou I">I Abdou</name></author><author><name sortKey="Parola, P" uniqKey="Parola P">P Parola</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Habib, Ag" uniqKey="Habib A">AG Habib</name></author><author><name sortKey="Kuznik, A" uniqKey="Kuznik A">A Kuznik</name></author><author><name sortKey="Hamza, M" uniqKey="Hamza M">M Hamza</name></author><author><name sortKey="Abdullahi, Mi" uniqKey="Abdullahi M">MI Abdullahi</name></author><author><name sortKey="Chedi, Ba" uniqKey="Chedi B">BA Chedi</name></author><author><name sortKey="Chippaux, Jp" uniqKey="Chippaux J">JP Chippaux</name></author><author><name sortKey="Warrell, Da" uniqKey="Warrell D">DA Warrell</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Hunink, Mg" uniqKey="Hunink M">MG Hunink</name></author><author><name sortKey="Glasziou, P" uniqKey="Glasziou P">P Glasziou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fox Rushby, Ja" uniqKey="Fox Rushby J">JA Fox-Rushby</name></author><author><name sortKey="Hanson, K" uniqKey="Hanson K">K Hanson</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Siegel, Je" uniqKey="Siegel J">JE Siegel</name></author><author><name sortKey="Weinstein, Mc" uniqKey="Weinstein M">MC Weinstein</name></author><author><name sortKey="Russell, Lb" uniqKey="Russell L">LB Russell</name></author><author><name sortKey="Gold, Mr" uniqKey="Gold M">MR Gold</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Husereau, D" uniqKey="Husereau D">D Husereau</name></author><author><name sortKey="Drummond, M" uniqKey="Drummond M">M Drummond</name></author><author><name sortKey="Petrou, S" uniqKey="Petrou S">S Petrou</name></author><author><name sortKey="Carswell, C" uniqKey="Carswell C">C Carswell</name></author><author><name sortKey="Moher, D" uniqKey="Moher D">D Moher</name></author><author><name sortKey="Greenberg, D" uniqKey="Greenberg D">D Greenberg</name></author><author><name sortKey="Augustovski, F" uniqKey="Augustovski F">F Augustovski</name></author><author><name sortKey="Briggs, Ah" uniqKey="Briggs A">AH Briggs</name></author><author><name sortKey="Mauskopf, J" uniqKey="Mauskopf J">J Mauskopf</name></author><author><name sortKey="Loder, E" uniqKey="Loder E">E Loder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goldie, Sj" uniqKey="Goldie S">SJ Goldie</name></author><author><name sortKey="Yazdanpanah, Y" uniqKey="Yazdanpanah Y">Y Yazdanpanah</name></author><author><name sortKey="Losina, E" uniqKey="Losina E">E Losina</name></author><author><name sortKey="Weinstein, Mc" uniqKey="Weinstein M">MC Weinstein</name></author><author><name sortKey="Anglaret, X" uniqKey="Anglaret X">X Anglaret</name></author><author><name sortKey="Walensky, Rp" uniqKey="Walensky R">RP Walensky</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Long, L" uniqKey="Long L">L Long</name></author><author><name sortKey="Fox, M" uniqKey="Fox M">M Fox</name></author><author><name sortKey="Sanne, I" uniqKey="Sanne I">I Sanne</name></author><author><name sortKey="Rosen, S" uniqKey="Rosen S">S Rosen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walensky, Rp" uniqKey="Walensky R">RP Walensky</name></author><author><name sortKey="Ross, El" uniqKey="Ross E">EL Ross</name></author><author><name sortKey="Kumarasamy, N" uniqKey="Kumarasamy N">N Kumarasamy</name></author><author><name sortKey="Wood, R" uniqKey="Wood R">R Wood</name></author><author><name sortKey="Noubary, F" uniqKey="Noubary F">F Noubary</name></author><author><name sortKey="Paltiel, D" uniqKey="Paltiel D">D Paltiel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Van Hoek, Aj" uniqKey="Van Hoek A">AJ van Hoek</name></author><author><name sortKey="Ngama, M" uniqKey="Ngama M">M Ngama</name></author><author><name sortKey="Ismail, A" uniqKey="Ismail A">A Ismail</name></author><author><name sortKey="Chuma, J" uniqKey="Chuma J">J Chuma</name></author><author><name sortKey="Cheburet, S" uniqKey="Cheburet S">S Cheburet</name></author><author><name sortKey="Mutonga, D" uniqKey="Mutonga D">D Mutonga</name></author><author><name sortKey="Kamau, T" uniqKey="Kamau T">T Kamau</name></author><author><name sortKey="Nokes, Dj" uniqKey="Nokes D">DJ Nokes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Patel, Hd" uniqKey="Patel H">HD Patel</name></author><author><name sortKey="Roberts, Et" uniqKey="Roberts E">ET Roberts</name></author><author><name sortKey="Constela, Do" uniqKey="Constela D">DO Constela</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goldie, Sj" uniqKey="Goldie S">SJ Goldie</name></author><author><name sortKey="O Hea, M" uniqKey="O Hea M">M O’Shea</name></author><author><name sortKey="Campos, Ng" uniqKey="Campos N">NG Campos</name></author><author><name sortKey="Dias, M" uniqKey="Dias M">M Dias</name></author><author><name sortKey="Sweet, S" uniqKey="Sweet S">S Sweet</name></author><author><name sortKey="Kim, Sy" uniqKey="Kim S">SY Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sinha, A" uniqKey="Sinha A">A Sinha</name></author><author><name sortKey="Levine, O" uniqKey="Levine O">O Levine</name></author><author><name sortKey="Knoll, Md" uniqKey="Knoll M">MD Knoll</name></author><author><name sortKey="Muhib, F" uniqKey="Muhib F">F Muhib</name></author><author><name sortKey="Lieu, Ta" uniqKey="Lieu T">TA Lieu</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="ppub">1935-2727</issn><issn pub-type="epub">1935-2735</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27027633</article-id><article-id pub-id-type="pmc">4814077</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0004568</article-id><article-id pub-id-type="publisher-id">PNTD-D-15-01785</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Animals</subject><subj-group><subject>Vertebrates</subject><subj-group><subject>Amniotes</subject><subj-group><subject>Reptiles</subject><subj-group><subject>Squamates</subject><subj-group><subject>Snakes</subject><subj-group><subject>Vipers</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Tropical Diseases</subject><subj-group><subject>Neglected Tropical Diseases</subject><subj-group><subject>Snakebite</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Economics</subject><subj-group><subject>Economic Analysis</subject><subj-group><subject>Cost-Effectiveness Analysis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Ears</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Head</subject><subj-group><subject>Ears</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Physiology</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Physiology</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Hematology</subject><subj-group><subject>Blood</subject><subj-group><subject>Blood Counts</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Animals</subject><subj-group><subject>Vertebrates</subject><subj-group><subject>Amniotes</subject><subj-group><subject>Reptiles</subject><subj-group><subject>Squamates</subject><subj-group><subject>Snakes</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Geographical Locations</subject><subj-group><subject>Africa</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pharmacology</subject><subj-group><subject>Adverse Reactions</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Cost-Effectiveness of Antivenoms for Snakebite Envenoming in 16 Countries in West Africa</article-title><alt-title alt-title-type="running-head">Cost-Effectiveness of Antivenoms for Snakebite in West Africa</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Hamza</surname><given-names>Muhammad</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Idris</surname><given-names>Maryam A.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Maiyaki</surname><given-names>Musa B.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lamorde</surname><given-names>Mohammed</given-names></name><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chippaux</surname><given-names>Jean-Philippe</given-names></name><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Warrell</surname><given-names>David A.</given-names></name><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kuznik</surname><given-names>Andreas</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Habib</surname><given-names>Abdulrazaq G.</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>College of Health of Sciences, Bayero University, Kano, Nigeria</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Institut de Recherche pour le Development, Cotonou, Benin Republic and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France</addr-line></aff><aff id="aff004"><label>4</label><addr-line>Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom</addr-line></aff><aff id="aff005"><label>5</label><addr-line>Celgene Corporation, Warren, New Jersey, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>de Silva</surname><given-names>H Janaka</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of Kelaniya, SRI LANKA</addr-line></aff><author-notes><fn fn-type="conflict" id="coi001"><p>At the time of the analysis, AK was employed by Celgene Corporation, with ownership of stock in Celgene Corporation.</p></fn><fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: AGH AK ML MAI MBM MH DAW JPC. Performed the experiments: AGH AK ML. Analyzed the data: AGH AK ML MAI MBM MH DAW JPC. Contributed reagents/materials/analysis tools: AGH AK ML. Wrote the paper: AGH AK ML MAI MBM MH DAW JPC.</p></fn><corresp id="cor001">* E-mail: <email>abdulrazaq_habib@yahoo.co.uk</email></corresp></author-notes><pub-date pub-type="epub"><day>30</day><month>3</month><year>2016</year></pub-date><pub-date pub-type="collection"><month>3</month><year>2016</year></pub-date><volume>10</volume><issue>3</issue><elocation-id>e0004568</elocation-id><history><date date-type="received"><day>19</day><month>10</month><year>2015</year></date><date date-type="accepted"><day>2</day><month>3</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Hamza et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Hamza et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="pntd.0004568.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>Snakebite poisoning is a significant medical problem in agricultural societies in Sub Saharan Africa. Antivenom (AV) is the standard treatment, and we assessed the cost-effectiveness of making it available in 16 countries in West Africa.</p></sec><sec id="sec002"><title>Methods</title><p>We determined the cost-effectiveness of AV based on a decision-tree model from a public payer perspective. Specific AVs included in the model were Antivipmyn, FAV Afrique, EchiTab-G and EchiTab-Plus. We derived inputs from the literature which included: type of snakes causing bites (carpet viper (<italic>Echis</italic> species)/non-carpet viper), AV effectiveness against death, mortality without AV, probability of Early Adverse Reactions (EAR), likelihood of death from EAR, average age at envenomation in years, anticipated remaining life span and likelihood of amputation. Costs incurred by the victims include: costs of confirming and evaluating envenomation, AV acquisition, routine care, AV transportation logistics, hospital admission and related transportation costs, management of AV EAR compared to the alternative of free snakebite care with ineffective or no AV. Incremental Cost Effectiveness Ratios (ICERs) were assessed as the cost per death averted and the cost per Disability-Adjusted-Life-Years (DALY) averted. Probabilistic Sensitivity Analyses (PSA) using Monte Carlo simulations were used to obtain 95% Confidence Intervals of ICERs.</p></sec><sec id="sec003"><title>Results</title><p>The cost/death averted for the 16 countries of interest ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra Leone. The cost/DALY averted ranged from $83 (95% Confidence Interval: $36-$240) for Benin Republic to $281 ($159–457) for Sierra-Leone. In all cases, the base-case cost/DALY averted estimate fell below the commonly accepted threshold of one time per capita GDP, suggesting that AV is highly cost-effective for the treatment of snakebite in all 16 WA countries. The findings were consistent even with variations of inputs in 1—way sensitivity analyses. In addition, the PSA showed that in the majority of iterations ranging from 97.3% in Liberia to 100% in Cameroun, Guinea Bissau, Mali, Nigeria and Senegal, our model results yielded an ICER that fell below the threshold of one time per capita GDP, thus, indicating a high degree of confidence in our results.</p></sec><sec id="sec004"><title>Conclusions</title><p>Therapy for SBE with AV in countries of WA is highly cost-effective at commonly accepted thresholds. Broadening access to effective AVs in rural communities in West Africa is a priority.</p></sec></abstract><abstract abstract-type="summary"><title>Author Summary</title><p>Antivenom is the main intervention against snakebite poisoning but is relatively scarce, unaffordable and the situation has been compounded further by the recent cessation of production of effective antivenoms and marketing of inappropriate products. Given this crisis, we assessed the cost effectiveness of providing antivenoms in West Africa by comparing costs associated with antivenom treatment against their health benefits in decreasing mortality. In the most comprehensive analyses ever conducted, it was observed the incremental cost effectiveness ratio of providing antivenom ranged from $1,997 in Guinea Bissau to $6,205 for Liberia and Sierra-Leone per death averted while cost per Disability Adjusted Life Year (DALY) averted ranged from $83 for Benin Republic to $281 for Sierra-Leone. There is probability of 97.3–100% that antivenoms are very cost-effective in the analyses. These demonstrate antivenom is highly cost-effective and compares favorably to other commonly funded healthcare interventions. Providing and broadening antivenom access throughout areas at risk in rural West Africa should be prioritized given the considerable reduction in deaths and DALYs that could be derived at a relatively small cost.</p></abstract><funding-group><funding-statement>The authors received no specific funding for this work.</funding-statement></funding-group><counts><fig-count count="3"></fig-count><table-count count="3"></table-count><page-count count="16"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the paper and its Supporting Information files.</p></notes></front></pmc><affiliations><list><country><li>France</li><li>Nigeria</li><li>Ouganda</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>New Jersey</li><li>Oxfordshire</li><li>Île-de-France</li></region><settlement><li>Oxford</li><li>Paris</li></settlement><orgName><li>Université Paris-Descartes</li><li>Université d'Oxford</li></orgName></list><tree><country name="Nigeria"><noRegion><name sortKey="Hamza, Muhammad" sort="Hamza, Muhammad" uniqKey="Hamza M" first="Muhammad" last="Hamza">Muhammad Hamza</name></noRegion><name sortKey="Habib, Abdulrazaq G" sort="Habib, Abdulrazaq G" uniqKey="Habib A" first="Abdulrazaq G." last="Habib">Abdulrazaq G. Habib</name><name sortKey="Idris, Maryam A" sort="Idris, Maryam A" uniqKey="Idris M" first="Maryam A." last="Idris">Maryam A. Idris</name><name sortKey="Kuznik, Andreas" sort="Kuznik, Andreas" uniqKey="Kuznik A" first="Andreas" last="Kuznik">Andreas Kuznik</name><name sortKey="Maiyaki, Musa B" sort="Maiyaki, Musa B" uniqKey="Maiyaki M" first="Musa B." last="Maiyaki">Musa B. Maiyaki</name></country><country name="Ouganda"><noRegion><name sortKey="Lamorde, Mohammed" sort="Lamorde, Mohammed" uniqKey="Lamorde M" first="Mohammed" last="Lamorde">Mohammed Lamorde</name></noRegion><name sortKey="Kuznik, Andreas" sort="Kuznik, Andreas" uniqKey="Kuznik A" first="Andreas" last="Kuznik">Andreas Kuznik</name></country><country name="France"><region name="Île-de-France"><name sortKey="Chippaux, Jean Philippe" sort="Chippaux, Jean Philippe" uniqKey="Chippaux J" first="Jean-Philippe" last="Chippaux">Jean-Philippe Chippaux</name></region></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Warrell, David A" sort="Warrell, David A" uniqKey="Warrell D" first="David A." last="Warrell">David A. Warrell</name></region></country><country name="États-Unis"><region name="New Jersey"><name sortKey="Kuznik, Andreas" sort="Kuznik, Andreas" uniqKey="Kuznik A" first="Andreas" last="Kuznik">Andreas Kuznik</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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